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Market Access

Payer Coverage Acceleration Through Economic Value Evidence

image of pharmacy community engagement activities
Client Profile

Mid-size Medtech

Key Stakeholders

Strategy & Market Access, Medical Affairs, Clinical Development, Product Manager

Asset

Launched

Disease Area

Spinal Cord Injury Rehabilitation

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Client Profile

Mid-size Medtech

Key Stakeholders

Strategy & Market Access, Medical Affairs, Clinical Development, Product Manager

Asset

Launched

Disease Area

Spinal Cord Injury Rehabilitation

Situation

The client was preparing to secure payer coverage for a newly launched medical device in the U.S.

While clinical benefit was clear, payers required a stronger articulation of medical necessity, economic value, and budget impact to support coverage and reimbursement decisions.

The client engaged Alkemi to develop a clear, evidence-based value case that could withstand payer scrutiny and support timely access.

Approach

1. Deployed a cross-functional team with expertise across market access, medical affairs, and economic modeling to define the payer value narrative.

2. Aligned internal stakeholders through working sessions focused on evidence inputs, assumptions, and messaging flow.

3. Validated budget impact assumptions through interviews with Key Opinion Leaders to ensure credibility in payer discussions.

The focus throughout:

Translate clinical benefit into payer-relevant economic value.

Deliverables

1
Payer Value Dossier articulating clinical and economic value to support coverage decisions.
2
Budget Impact Model (BIM) quantifying financial implications for payers.
3
Internal workshops and KOL interviews to refine assumptions, validate messaging, and prepare teams for payer engagement.
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Impact

"Alkemi’s thoughtful articulation of our product’s clinical and economic value was used in payer discussions and resulted in new CMS reimbursement." - Vice President, Strategy and Market Access

Faster Coverage Readiness:

Delivered a complete payer value case in weeks, enabling earlier and more effective payer discussions.

Credible Economic Justification:

Demonstrated manageable budget impact and economic rationale aligned with payer decision criteria.

Improved Access Outcomes:

Tools and messaging supported CMS benefit determination and strengthened payer communications.

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